Association between different proportions of crescents and the progression of IgA nephropathy (IgAN): a systematic review and meta-analysis.

IF 2.2 4区医学 Q2 UROLOGY & NEPHROLOGY

BMC Nephrology Pub Date : 2024-11-05 DOI:10.1186/s12882-024-03839-w

Li Yu, Hao Zhang, Yunfeng Wu

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引用次数: 0

Abstract

Background: Immunoglobulin A nephropathy (IgAN) is a complex renal disease with a highly variable clinical course. Identifying reliable prognostic markers is crucial for risk stratification and treatment decisions. This study aimed to understand the influence of different proportions of crescents (Cs) on the progression of IgAN.

Methods: Four databases (PubMed, Web of Science, Embase, and Cochrane Library) were searched until September 25, 2023. The study encompassed IgAN patients, focusing on kidney outcomes and end-stage kidney disease (ESKD). Statistical analysis included calculating hazard ratios (HR) for binary outcomes and examining publication bias.

Results: The meta-analysis involved thirteen studies comprising 11,849 patients. For kidney outcomes, crescent formation may be linked to an elevated risk (HR = 2.01, 95%CI 1.40-2.87, P < 0.001). Furthermore, significantly increased risks of kidney outcomes were observed with a crescent proportion > 10 (HR = 1.8, 95%CI 1.32-2.45, P < 0.001) and > 25%(HR = 2.11, 95% CI 1.47-3.02, P < 0.001). Regarding ESKD, a proportion > 25% also displayed an elevated risk (HR = 1.70, 95% CI 1.18-2.44, P = 0.004). However, a proportion > 10% (including > 25%) did not show a significant association with ESKD (HR = 1.12, 95% CI 0.36-3.47, P = 0.842) versus less.

Conclusions: This systematic review and meta-analysis established a strong association between crescent proportions and the progression of IgAN. Higher proportions, notably exceeding 25%, were reliable prognostic markers, indicating a greater risk of adverse kidney outcomes and ESKD. These findings have significant clinical implications, offering the potential for more precise risk stratification in IgAN patients.

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不同比例的新月体与 IgA 肾病 (IgAN) 进展之间的关系：系统回顾和荟萃分析。

背景：免疫球蛋白 A 肾病（IgAN免疫球蛋白 A 肾病（IgAN）是一种复杂的肾病，临床病程多变。确定可靠的预后标志物对于风险分层和治疗决策至关重要。本研究旨在了解不同比例的新月体（Cs）对 IgAN 进展的影响：搜索了四个数据库（PubMed、Web of Science、Embase 和 Cochrane Library），截止日期为 2023 年 9 月 25 日。研究对象包括 IgAN 患者，重点关注肾脏预后和终末期肾病 (ESKD)。统计分析包括计算二元结局的危险比（HR）和检查发表偏倚：荟萃分析涉及 13 项研究，共 11,849 名患者。就肾脏结果而言，新月体形成可能与风险升高有关（HR = 2.01，95%CI 1.40-2.87，P 10）（HR = 1.8，95%CI 1.32-2.45，P 25%）（HR = 2.11，95%CI 1.47-3.02，P 25%也显示风险升高（HR = 1.70，95%CI 1.18-2.44，P = 0.004））。然而，比例大于 10%（包括大于 25%）与小于 10%（HR = 1.12，95% CI 0.36-3.47，P = 0.842）相比，与 ESKD 的关系并不明显：这项系统回顾和荟萃分析确定了新月体比例与 IgAN 进展之间的密切联系。新月体比例越高，尤其是超过 25% 的新月体比例，是可靠的预后标志，表明出现不良肾脏预后和 ESKD 的风险越大。这些发现具有重要的临床意义，有可能对 IgAN 患者进行更精确的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMC Nephrology UROLOGY & NEPHROLOGY-

CiteScore

4.30

自引率

0.00%

发文量

375

审稿时长

3-8 weeks

期刊介绍： BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.